title: Epidural catheterization in cardiac surgery: the 2012 risk assessment.
abstract: OBJECTIVE
  The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012.
  
  
  METHODS
  We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports.
  
  
  RESULTS
  Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI) of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552).
  
  
  CONCLUSIONS
  The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.
authors.affiliation: Department of Anesthesiology, McGill University, Montreal, Canada and University of Pisa, Pisa, Italy.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Hemmerling
authors.forename: Shantale
authors.initials: S
authors.lastname: Cyr
authors.forename: Nora
authors.initials: N
authors.lastname: Terrasini
mesh_terms: D015360:Analgesia, Epidural / Q000009:adverse effects*; D000767:Anesthesia, Epidural / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures; D002404:Catheterization / Q000009:adverse effects*; D046748:Hematoma, Epidural, Spinal / Q000209:etiology*; D006801:Humans; D018570:Risk Assessment